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Wednesday, 21 August 2013

Risk verses reward

I’m not quite sure when it happened, but it seems that wrapping human beings up in cotton wool has become a habit that many individuals and organisations are struggling to get out of. Prime candidates for this approach are anyone who is older and considered to be vulnerable through their health or circumstances. For anyone who falls into this category, the cotton wool approach is likely to become the standard response to ‘caring’ for you.

In the UK, and I’m sure further afield too, we have become very risk adverse. Since just about everything in life has some risk attached to it, it seems that a return to the womb may be the only option to ensure we remain truly safe. With reverse births yet to be pioneered, however, perhaps it is worth proposing an alternative approach – let’s put risk back into living, mainly because life without it really isn’t life at all.

I’m all for ensuring that people with frailties are cared for with due recognition of what is making them more fragile, but risk aversion has gone too far. In many health and care settings, people are expected to remain seated or in bed because of the risk of falls, even though many are capable of being more mobile and would benefit from being so, not least in reducing the instances of pressure sores and infections.

I’ve seen food and drinks left out of reach of people until they are cold, simply because of the risk that these items could prove to be too warm to consume. Personally I am not a fan of cold tea or coffee, so taking this approach with me certainly wouldn’t encourage me to keep hydrated. Doors to the outside are kept locked because of the risks associated with going outside – getting burnt in the sun, catching a chill in the cooler weather or getting wet, despite the fact that sun cream and clothing are readily available to prevent all of these eventualities.

You can take it further too. Banning animal therapy because of the risk of spreading diseases. Avoiding arts and crafts because of the risk that paint or other substances could be ingested. Preventing someone from making their own drink or preparing a simple meal because of the risk that they might burn or cut themselves. Banning gardening in case someone over-stretches themselves with a task, or eats something they shouldn’t. Only allowing people to bath or shower when absolutely necessary because of the risk of them slipping when they are wet and soapy.

The list is endless, the point is that taking away risk means basically condemning someone who has needs, capabilities, wants and desires to a vegetative state that isn’t of their making. I have written previously about the need we all have for a sense of achievement, but this can only come from allowing us some risk in our lives. Letting people do as much as they are able to, and supporting them to excel and potentially push themselves even further, can be frightening but also very rewarding for them and for the professionals caring for them when they do something that they were never considered able to do.

The compromise is to manage risk. You wouldn’t necessarily help someone with a heart condition to go bungee jumping, but you could help them to go outside and sit in a swing in the sunshine. You would be irresponsible to leave a person with advancing dementia alone in a kitchen with numerous safety hazards, but you could be there with them and help them to make themselves tea and toast for breakfast. Indeed many activities that are considered risky can have their risk reduced through supervision and assistance.

Allowing the people we care for and love to have some risk in their life isn’t easy. We want to keep them safe, protecting them from all harm or potential for pain or upset. But it can never be considered good practice to become so risk adverse that you order those in your care to remain seated or in bed, thus condemning them to losing the use of their legs. Many people become more unsteady on their feet in later life, and especially when they are living with dementia, but numerous mobility aids exists to support someone to move around, and certainly in my dad’s case, items like hip protectors were also very helpful.

Sometimes I think care providers lose bravery. Away from their jobs, they can still go and have adventures and try new, exciting and sometimes scary things. It’s easy to forget that those needing their care are no different in wanting that feeling of the wind in their hair, the taste on their lips or the smile that comes from achievement. We hate the idea of losing our own independence, but by become risk adverse in our professional lives, we automatically deny the opportunity to experience the unexpected to those we are charged with caring for.

So next time you see risk, make sure you are also seeing the person. Are you really protecting them, or are you actually more concerned about protecting yourself? Are you guilty of seeing too many situations as risky, when in actual fact the risk is far more minimal than you realise, or could be virtually eliminated? Can you find a way to enable someone you are caring for to do something that they want to do rather than just dismissing it as too risky?

Finally, can you build more proactive risk taking into the daily life of the people you care for, so that they are actually living and not just waiting to die? 

Until next time...
Beth x







You can follow me on Twitter: @bethyb1886

2 comments:

  1. Hello Beth, great blog as usual! I'd just like to add that many risk assessments still do not consider and list the benefits (to the person) of taking the risk, and also how important taking the risk is to the person.
    They should also consider what possible harm might be done to the person if the risk is not taken. This information usually leads to a more balanced, positive approach to supporting risk-taking.
    Of course, working for an organisation with a learning - rather than blaming - culture helps!
    Keep up the great blog, Rose

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  2. Hello Beth my lovely imaginary friend!
    This is such a great blog, something dear to my heart too.
    Only yesterday at a SA Department of Health workshop I suggested the elderly should be able to make up their own mind about taking risks... they have made their own choices to take them all their lives, jumping from planes, bungys, etc, so it is a little odd that suddenly those much younger than them decide for them if they can take risks later in life...
    Having worked in aged and dementia care, I completely understand the 'duty of care' factor, but still think service providers have taken it too far.
    "Actually living, not waiting to die" ... I love it! Fits perfectly with my mantras.
    Take care xox

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